Kidney stones can be incredibly painful—but having a kidney stone does not always mean you need surgery.

Kidney stones, also called renal calculi or nephrolithiasis, develop when minerals and other substances in the urine become concentrated and form crystals. These crystals can grow into stones that remain in the kidney or travel into the ureter, the narrow tube that carries urine from the kidney to the bladder.

Some kidney stones cause no symptoms at all. Others can cause some of the most severe pain a person has ever experienced.

At UroLux Concierge, our approach to kidney stones is individualized. The right treatment depends on factors including the stone’s size, location, composition, symptoms, degree of obstruction, presence of infection, kidney function, anatomy, and your personal preferences and circumstances.

Sometimes the best treatment is simply observation and allowing a small stone to pass naturally. Other times, a procedure may be recommended to remove the stone and protect kidney function.

What Does a Kidney Stone Feel Like?

Kidney stone symptoms can vary considerably depending on where the stone is located.

Common symptoms include:

• Severe pain in the back or side
• Pain that radiates toward the abdomen or groin
• Pain that comes and goes in waves
• Nausea or vomiting
• Blood in the urine
• Urinary urgency or frequency
• Burning with urination
• Difficulty urinating
• Cloudy or foul-smelling urine

A stone moving from the kidney into the ureter can cause particularly intense pain because the ureter may spasm around the stone.

However, not every kidney stone causes pain. Some stones are discovered incidentally during imaging performed for another reason.

Do All Kidney Stones Need Treatment?

No.

Small stones that are not causing obstruction, infection, significant symptoms, or deterioration in kidney function may sometimes be safely monitored.

The likelihood that a stone will pass on its own depends on several factors, particularly stone size and location.

When observation is appropriate, your urologist may recommend:

• Hydration appropriate for your medical condition
• Pain control
• Periodic imaging
• Monitoring kidney function
• Medical expulsive therapy in selected patients
• Straining the urine to capture the stone for analysis

The decision to observe versus actively remove a stone should be individualized.

Treatment may become appropriate if the stone:

• Causes significant or recurrent pain
• Blocks the flow of urine
• Causes recurrent infections
• Grows over time
• Is associated with kidney dysfunction
• Is unlikely to pass on its own
• Creates a significant risk based on its location or size
• Interferes with the patient’s lifestyle, work, or travel

Patient preference is also an important consideration.

Hydration: One of the Most Important Ways to Prevent Kidney Stones

If you have formed a kidney stone, prevention should begin even after the immediate episode has resolved.

Hydration is one of the cornerstones of kidney stone prevention.

The goal is to produce enough urine to keep stone-forming substances diluted.

For many stone formers, this means drinking fluids consistently throughout the day rather than drinking large amounts all at once.

Your ideal fluid intake depends on your stone type, activity level, climate, kidney function, heart health, medications, and other individual factors.

If you have a medical condition requiring fluid restriction, you should follow your physician’s recommendations rather than simply increasing your water intake.

Don’t Assume All Kidney Stones Are the Same

There are several different types of kidney stones.

The most common include:

• Calcium oxalate stones
• Calcium phosphate stones
• Uric acid stones
• Struvite or infection-related stones
• Cystine stones

Knowing the type of stone you have can be extremely valuable because prevention strategies can differ.

Whenever possible, a stone that has been passed or removed can be sent for stone analysis.

For patients with recurrent stones, a metabolic evaluation may also be appropriate. This can include blood testing and a 24-hour urine collection to evaluate factors such as urine volume, calcium, oxalate, citrate, uric acid, sodium, and other stone-forming characteristics.

The goal isn’t simply to treat today’s stone.

The goal is to prevent the next one.

Dietary Strategies for Kidney Stone Prevention

Dietary recommendations should be individualized based on your stone composition and metabolic evaluation, but several general principles are commonly important.

Drink enough fluid

Adequate urine volume helps dilute substances that can form stones.

Don’t eliminate dietary calcium without medical advice

It may seem logical that eating less calcium would prevent calcium stones. In many patients, however, normal dietary calcium intake is important, and unnecessarily restricting calcium can actually be counterproductive.

Watch your sodium intake

Higher dietary sodium can increase urinary calcium excretion in susceptible individuals.

Moderate excessive animal protein

High intake of animal protein can influence urinary chemistry and may increase the risk of certain types of stones.

Maintain a healthy diet

A balanced diet rich in fruits and vegetables can contribute to favorable urinary chemistry, including citrate levels.

Your stone prevention plan should be tailored to your specific stone type and metabolic risk factors, rather than following a one-size-fits-all diet.

When Is Kidney Stone Surgery Necessary?

When a kidney stone needs to be removed, there are several treatment options.

The three most common modern procedures are:

1. Shock Wave Lithotripsy (SWL)
2. Ureteroscopy with Laser Lithotripsy
3. Percutaneous Nephrolithotomy (PCNL)

The choice depends heavily on stone size and location, anatomy, stone composition, imaging characteristics, and patient-specific factors.

Let’s take a closer look.

1. Shock Wave Lithotripsy (SWL)

Shock wave lithotripsy, sometimes called ESWL, is a noninvasive treatment that uses externally generated shock waves to break a kidney or ureteral stone into smaller pieces.

The stone fragments can then pass naturally through the urinary tract.

What happens during SWL?

The patient is positioned so that the stone can be precisely targeted using imaging.

A lithotripter then delivers a series of shock waves directed at the stone.

The goal is to fragment the stone into smaller pieces that can pass through the urinary tract.

Advantages of SWL

• No incision into the kidney
• Less invasive than PCNL
• Often performed as an outpatient procedure
• Generally shorter recovery
• Can be an excellent option for appropriately selected stones

Limitations of SWL

SWL isn’t ideal for every stone.

Success can be affected by:

• Stone size
• Stone location
• Stone composition
• Stone density on CT
• Distance between the skin and stone
• Patient anatomy

Some patients require more than one treatment session.

For appropriately selected stones, SWL remains an important treatment option.

2. Ureteroscopy With Laser Lithotripsy

Ureteroscopy (URS) is one of the most commonly performed procedures for kidney and ureteral stones.

Unlike SWL, ureteroscopy allows the urologist to directly visualize the stone.

A small camera called a ureteroscope is passed through the natural urinary passage:

Urethra → bladder → ureter → kidney

No external incision is required.

Once the stone is identified, a laser can be used to break the stone into smaller fragments. Depending on the situation, fragments may be removed with a small basket or allowed to pass.

Modern laser technology, including holmium:YAG and thulium fiber lasers, is used for stone fragmentation.

Advantages of ureteroscopy

• Direct visualization of the stone
• Can treat both ureteral and many kidney stones
• High likelihood of achieving a stone-free result with a single procedure
• Particularly useful for stones in locations where SWL may be less effective
• Can be used when certain patient factors make SWL less desirable

What about a ureteral stent?

A temporary ureteral stent may be placed after ureteroscopy.

A stent is a small flexible tube that helps maintain urine drainage while the ureter heals.

Not every uncomplicated ureteroscopy requires a stent, although stents are frequently used depending on the circumstances.

Stents can cause temporary symptoms such as:

• Urinary frequency
• Urgency
• Bladder discomfort
• Flank discomfort
• Blood in the urine

Your urologist will determine whether a stent is appropriate and how long it should remain.

3. Percutaneous Nephrolithotomy (PCNL)

For large or complex kidney stones, particularly stones larger than approximately 2 centimeters, percutaneous nephrolithotomy (PCNL) is often the preferred surgical approach.

Unlike ureteroscopy, PCNL accesses the kidney directly through a small incision in the back.

A tract is created from the skin into the kidney, allowing specialized instruments to reach and remove or fragment the stone.

Why use PCNL?

PCNL is particularly effective for:

• Large kidney stones
• Multiple large stones
• Complex stone burdens
• Staghorn calculi
• Stones that are unlikely to be effectively treated with SWL or ureteroscopy alone

Current EAU guidance recommends PCNL as the primary treatment for renal stones larger than 2 cm in appropriate candidates.

Is PCNL more invasive?

Yes.

PCNL is more invasive than SWL and ureteroscopy, but its major advantage is the ability to remove a substantial amount of stone burden efficiently.

For very large stones, attempting multiple less-invasive procedures may ultimately require more treatments than performing PCNL.

The appropriate choice depends on the individual patient’s anatomy, health, stone burden, and goals.

What About Robotic or Open Kidney Stone Surgery?

With modern advances in endourology, open surgery and laparoscopic or robotic stone surgery are rarely necessary for routine kidney stones.

Most stones can be managed with SWL, ureteroscopy, or PCNL.

Open or laparoscopic approaches may occasionally be considered in unusual or highly complex cases when standard endoscopic approaches are unlikely to succeed or have failed.

An Infected, Obstructed Kidney Stone Is an Emergency

One situation deserves special attention:

A blocked kidney + infection can be a urologic emergency.

If a stone blocks the urinary tract and the patient develops signs of infection, urgent drainage of the kidney may be necessary.

Symptoms may include:

• Fever
• Chills
• Severe illness
• Flank pain
• Nausea or vomiting
• Rapid heart rate
• Confusion or weakness

In this situation, the priority is not immediately removing the stone.

The first priority is to drain the infected, obstructed urinary system and treat the infection.

Drainage can be accomplished with either a ureteral stent or a percutaneous nephrostomy tube, depending on the circumstances.

Definitive stone treatment is generally performed after the acute infection has been appropriately managed. The EAU classifies an infected obstructed kidney as a urologic emergency requiring urgent decompression.

If you have a known kidney stone and develop fever or chills, worsening pain, vomiting, or feel significantly ill, seek urgent medical attention.

Which Kidney Stone Procedure Is Right for You?

There isn’t a single “best” kidney stone procedure for everyone.

A simplified comparison looks like this:

Procedure	How it works	Typical role
SWL	External shock waves break the stone	Selected kidney/ureteral stones
Ureteroscopy + laser	Camera reaches the stone and laser fragments it	Many ureteral and kidney stones
PCNL	Small tract directly into kidney removes stone	Large/complex kidney stones
Laparoscopic/robotic/open surgery	Surgical removal through an operative approach	Rare, highly selected cases

Your urologist will consider the size, location, number, density, and composition of the stones, as well as your anatomy and overall health, when recommending treatment.

After a Kidney Stone: Don’t Stop at Stone Removal

Removing a stone treats the immediate problem.

But if you have formed one kidney stone, there may be a reason you formed it.

That is why stone prevention is such an important part of long-term urologic care.

Depending on your history, your urologist may recommend:

• Stone analysis
• Blood testing
• 24-hour urine testing
• Review of dietary habits
• Increased fluid intake
• Sodium reduction
• Dietary modifications
• Medications to reduce future stone formation
• Follow-up imaging

For patients with recurrent stones, identifying the underlying metabolic risk can be particularly valuable.

Kidney Stone Prevention Is Personalized Medicine

Kidney stones are not simply a problem of “not drinking enough water.”

They can result from a complex interaction between genetics, diet, hydration, urinary chemistry, anatomy, medications, medical conditions, and environmental factors.

At UroLux Concierge, we believe kidney stone care should address both sides of the problem:

Treat the stone you have.

And:

Understand why you formed it in the first place.

Whether you have a newly diagnosed kidney stone, recurrent stones, or questions about whether a stone requires surgery, a personalized urologic evaluation can help determine the safest and most effective approach.

Personalized Urologic Care

UroLux Concierge provides personalized, physician-led urologic care with an emphasis on comprehensive evaluation, prevention, and individualized treatment.

If you are experiencing recurrent kidney stones or have been told that you need a kidney stone procedure, an individualized evaluation can help you understand your options—including whether observation, SWL, ureteroscopy, or PCNL may be appropriate.

Don’t just treat the stone. Treat the reason you formed it.

This article is intended for educational purposes and does not replace individualized medical evaluation. Treatment decisions should be made with a qualified healthcare professional based on the patient’s symptoms, imaging, medical history, anatomy, stone characteristics, and overall health.

 

Making Kidney Stone Treatment More Accessible

At UroLux Concierge, we believe that high-quality urologic care should also be transparent and accessible. The cost of a kidney stone procedure can sometimes feel overwhelming when physician fees, facility fees, anesthesia, imaging, and other services are billed separately.

That’s why UroLux Concierge works with select surgery centers that offer all-inclusive, transparent pricing for eligible procedures. By coordinating care with these facilities, we may be able to help patients better understand their total out-of-pocket costs and, in appropriate circumstances, reduce the overall expense of kidney stone treatment.

Rather than navigating multiple bills and unexpected facility charges, an all-inclusive surgical package may combine many of the costs associated with the procedure into one transparent price. This can be particularly valuable for patients who are self-pay, have high-deductible insurance plans, or are looking for a more predictable cost for their care.

Our concierge model allows us to help coordinate the process—from determining whether surgery is necessary, to selecting the appropriate procedure and surgery center, to helping patients understand the anticipated costs before treatment.

We believe patients should know what their care is going to cost whenever possible—before they walk into the operating room.

Because exceptional urologic care isn’t just about finding the right treatment. It’s also about finding a treatment that makes sense for you, your health, and your budget.

All-inclusive pricing and cost savings are dependent on the specific procedure, surgery center, anesthesia requirements, patient circumstances, and other factors. Patients should receive an individualized cost estimate before proceeding with treatment.